1750684809 NPI number — HOME AGAIN OF SOUTHWEST FLORIDA,INC.

Table of content: (NPI 1750684809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750684809 NPI number — HOME AGAIN OF SOUTHWEST FLORIDA,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME AGAIN OF SOUTHWEST FLORIDA,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750684809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 380183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURDOCK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33938-0183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-743-4857
Provider Business Mailing Address Fax Number:
800-921-4989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1357 RAMSDEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-2887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-743-4857
Provider Business Practice Location Address Fax Number:
800-921-4989
Provider Enumeration Date:
12/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ASHLEY
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-743-4857

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 678473996 . This is a "MEDICAID WAIVER" identifier . This identifiers is of the category "OTHER".




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